Provider Demographics
NPI:1366073421
Name:ASPIRE TELEPSYCHIATRY
Entity type:Organization
Organization Name:ASPIRE TELEPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-638-0217
Mailing Address - Street 1:1115 MADISON ST NE # 254
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7862
Mailing Address - Country:US
Mailing Address - Phone:877-277-4739
Mailing Address - Fax:
Practice Address - Street 1:1910 24TH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8150
Practice Address - Country:US
Practice Address - Phone:704-322-0863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty